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Vulnerabilidad de la obesidad definida por el índice de masa corporal, perímetro abdominal y porcentaje de grasa corporal
Vulnerability of obesity as defined by body mass index, waist circumference, and body fat percentage
Ricardo Ortegaa,
Autor para correspondencia
Ricardo.Ortega3@alu.uclm.es

Autor para correspondencia.
, Gonzalo Grandesb, Sagrario Gómez-Cantarinoc, en nombre del Grupo PEPAF
a Centro de Salud de Santa Bárbara, Servicio de Salud de Castilla-La Mancha, Toledo, España
b Unidad de Investigación en Atención Primaria de Bizkaia, Servicio Vasco de Salud (Otsakidetza), Bilbao, España
c Departamento de Enfermería, Fisioterapia y Terapia Ocupacional, Facultad de Fisioterapia y Enfermería, Universidad de Castilla-La Mancha, Toledo, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La obesidad&#44; entendida como un exceso de grasa corporal &#40;EGC&#41;&#44; se considera una enfermedad cr&#243;nica similar a la hipertensi&#243;n arterial&#44; la diabetes o la dislipemia<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1-3</span></a>&#44; y cuando se acumula en el abdomen en forma de grasa visceral y subcut&#225;nea se considera obesidad abdominal &#40;OA&#41;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">4</span></a>&#46; Las enfermedades cr&#243;nicas no se curan&#44; solo se controlan con el tratamiento&#46; Pero&#44; en la obesidad&#44; una persona puede perder ese exceso de grasa y convertirse en una persona con grasa normal a la que considerar sin obesidad y&#44; por tanto&#44; su enfermedad habr&#225; desaparecido&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La acumulaci&#243;n de la grasa corporal en exceso se debe a un balance energ&#233;tico positivo del organismo&#44; en el que las calor&#237;as que se ingieren con la alimentaci&#243;n &#40;ingesta energ&#233;tica&#41; superan a las calor&#237;as gastadas en todas las actividades que la persona realiza en 24<span class="elsevierStyleHsp" style=""></span>horas&#44; incluido el sue&#241;o &#40;gasto cal&#243;rico&#41;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a>&#46; Esas calor&#237;as ingeridas que no se gastan se almacenan en forma de grasa&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La ingesta energ&#233;tica y el gasto cal&#243;rico constituyen h&#225;bitos de vida presentes en todas las personas y en todo momento&#46; Por eso es posible que&#44; igual que han generado un balance energ&#233;tico positivo que les ha producido obesidad&#44; generen despu&#233;s un balance negativo que les produzca la desaparici&#243;n de esa obesidad&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Para diagnosticar obesidad en las consultas de atenci&#243;n primaria se utilizan&#58; el &#237;ndice de masa corporal &#40;IMC&#41;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1-3</span></a>&#44; el per&#237;metro abdominal &#40;PA&#41;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">4</span></a> y el porcentaje de grasa corporal &#40;PGC&#41;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Pr&#225;cticamente todos los estudios sobre las intervenciones en obesidad pretenden valorar la reducci&#243;n del peso y&#47;o la grasa que esas intervenciones producen<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a>&#44; pero no buscan la proporci&#243;n de personas obesas capaces de dejar de serlo&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El objetivo del presente estudio es cuantificar la proporci&#243;n de pacientes de atenci&#243;n primaria que son capaces de normalizar el IMC&#44; el PA o el PGC al cabo de 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; as&#237; como los factores que se asocian con la probabilidad de dejar de tener obesidad&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Material y m&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Este estudio se ha realizado con datos secundarios del estudio PEPAF&#44; que no fueron analizados en el estudio original&#44; en forma de estudio de observaci&#243;n longitudinal y retrospectiva&#46; El estudio PEPAF era un ensayo cl&#237;nico realizado en 11 centros de salud espa&#241;oles&#44; entre 2003 y 2006&#44; con distribuci&#243;n aleatoria de los centros a un grupo de intervenci&#243;n o a un grupo control&#46; Este estudio evalu&#243; la efectividad de un Programa Experimental de Promoci&#243;n de la Actividad F&#237;sica para aumentar los niveles de actividad f&#237;sica &#40;AF&#41; de la poblaci&#243;n sedentaria de 20 a 80<span class="elsevierStyleHsp" style=""></span>a&#241;os consultante en atenci&#243;n primaria&#46; Para ello se reclut&#243; una muestra de pacientes sin enfermedad cardiovascular conocida y sedentarios de acuerdo a un algoritmo&#44; practic&#225;ndose las mediciones del estudio a 4&#46;927 participantes que cumpl&#237;an esas condiciones&#46; Posteriormente se les pas&#243; a todos los participantes el <span class="elsevierStyleItalic">Physical Activity Readiness Questionnaire</span> &#40;PAR-Q&#41;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a> para asegurar su sedentarismo&#44; y se identificaron 850 participantes f&#237;sicamente activos que fueron excluidos del ensayo cl&#237;nico&#44; cuya cohorte para dicho ensayo qued&#243; establecida en 4&#46;317 participantes&#46; Estos participantes firmaron un consentimiento informado y se les sigui&#243; durante 2<span class="elsevierStyleHsp" style=""></span>a&#241;os con mediciones en la captaci&#243;n y a los 6&#44; 12 y 24<span class="elsevierStyleHsp" style=""></span>meses<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9-11</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A los participantes de intervenci&#243;n se les clasific&#243; en preparados para modificar su nivel de AF y no preparados&#44; de acuerdo con una versi&#243;n reducida del modelo transte&#243;rico de las etapas de cambio<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a>&#46; A ambos grupos se les proporcion&#243; una recomendaci&#243;n m&#233;dica asertiva personalizada&#44; de acuerdo con las evidencias disponibles sobre los beneficios del ejercicio y los riesgos de la inactividad&#46; Los participantes no preparados recibieron un folleto centrado en la modificaci&#243;n de creencias sobre la AF&#44; y de forma oportuna volvieron a ser abordados en consultas posteriores para conocer su intenci&#243;n de modificar su h&#225;bito sedentario&#46; A los participantes preparados se les cit&#243; para realizar una consulta adicional de menos de 20<span class="elsevierStyleHsp" style=""></span>minutos de duraci&#243;n para abordar las posibles barreras anticipadas por el participante &#40;en cuanto a falta de tiempo&#44; recursos o problemas de salud&#41;&#44; y se negoci&#243; con ellos un Plan de Actividad F&#237;sica &#40;PAF&#41; centrado en el cumplimiento y superaci&#243;n de las recomendaciones de los <span class="elsevierStyleItalic">Centers for Disease Control and Prevention</span><a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a>&#46; El PAF se entreg&#243; al participante a modo de prescripci&#243;n y se evalu&#243; de forma oportunista en las siguientes consultas&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El Estudio PEPAF cumpl&#237;a las directrices de la Declaraci&#243;n de Helsinki y su protocolo<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a> fue aprobado por los Comit&#233;s &#201;ticos de Investigaci&#243;n Cl&#237;nica &#40;CEIC&#41; de los centros participantes &#40;ClinicalTrials&#46;gov Identifier&#58; NCT00131079&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Poblaci&#243;n</span><p id="par0050" class="elsevierStylePara elsevierViewall">Para el presente estudio se eligieron&#44; de entre los 4&#46;927 participantes con mediciones basales&#44; a los que ten&#237;an un IMC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;246&#41; para la obesidad general &#40;OG&#41;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a>&#44; a los hombres y mujeres que ten&#237;an&#44; respectivamente&#44; un PA<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>102<span class="elsevierStyleHsp" style=""></span>cm y &#62;<span class="elsevierStyleHsp" style=""></span>88<span class="elsevierStyleHsp" style=""></span>cm &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;122&#41; para la OA<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">4&#44;14</span></a> y a los hombres y mujeres que ten&#237;an&#44; respectivamente&#44; un PGC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; y &#62;<span class="elsevierStyleHsp" style=""></span>35&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;436&#41; para el EGC<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">6&#44;15&#44;16</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Mediciones</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se seleccionaron las siguientes variables sociodemogr&#225;ficas basales del Estudio PEPAF&#58; sexo&#44; edad y diagn&#243;sticos de diabetes&#44; hipertensi&#243;n arterial y dislipemia&#59; y tambi&#233;n h&#225;bito tab&#225;quico&#44; niveles de AF&#44; cumplimiento de las recomendaciones de AF y mediciones de consumo m&#225;ximo de ox&#237;geno &#40;VO<span class="elsevierStyleInf">2</span>max&#41;&#44; peso&#44; talla&#44; PA y tres pliegues grasos cut&#225;neos &#40;tor&#225;cico&#44; umbilical y muslo anterior para hombres&#44; y tr&#237;ceps&#44; suprail&#237;aco y muslo anterior para mujeres&#41;&#44; correspondientes a las visitas de captaci&#243;n y a los 6&#44; 12 y 24<span class="elsevierStyleHsp" style=""></span>meses&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El h&#225;bito tab&#225;quico se obtuvo por autodeclaraci&#243;n&#44; y se codific&#243; como fumador y no fumador&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se consideraron como en inactividad f&#237;sica los participantes que no cumpl&#237;an las recomendaciones de AF &#40;al menos 30<span class="elsevierStyleHsp" style=""></span>minutos de AF moderada 5<span class="elsevierStyleHsp" style=""></span>d&#237;as a la semana&#44; o 20<span class="elsevierStyleHsp" style=""></span>minutos de AF vigorosa 20<span class="elsevierStyleHsp" style=""></span>minutos a la semana&#44; o combinaciones h&#237;bridas de episodios de AF moderada e intensa&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a> seg&#250;n su AF habitual&#46; La medici&#243;n de la AF se hizo con el cuestionario PAR-Q<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El VO<span class="elsevierStyleInf">2</span>max se estim&#243; de forma indirecta utilizando el protocolo YMCA-ACSM<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> en una prueba de esfuerzo subm&#225;ximo con un cicloerg&#243;metro VarioBike 500 y fue estandarizado para edad&#44; sexo y frecuencia cardiaca de reposo&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">El peso y la estatura se midieron en una b&#225;scula de consulta calibrada y con tall&#237;metro&#44; con el participante descalzo y con la ropa m&#237;nima&#44; y manteniendo la cabeza en posici&#243;n de alineamiento de la nariz y la oreja&#44; y se calcul&#243; el IMC mediante la f&#243;rmula&#58; peso &#40;kg&#41;&#47;talla<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#40;m&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">El PA se midi&#243; con el paciente tumbado en la camilla&#44; con el abdomen descubierto&#44; y rodeando el abdomen a nivel del ombligo con una cinta m&#233;trica plastificada&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Los pliegues grasos cut&#225;neos se midieron siguiendo los protocolos estandarizados de Jackson y Pollock<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a>&#44; y con ellos se obtuvo la densidad corporal que se llev&#243; a la f&#243;rmula de Siri<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a> para obtener el PGC&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La forma f&#237;sica cardiorrespiratoria &#40;FFCR&#41; de los participantes se categoriz&#243; en baja&#44; media y alta seg&#250;n los tertiles de VO<span class="elsevierStyleInf">2</span>max en cada sexo&#44; considerando FFCR buena al tertil de alta y mala a los otros dos&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Variables de resultados</span><p id="par0095" class="elsevierStylePara elsevierViewall">Proporciones de participantes que hab&#237;an normalizado su IMC &#40;&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; su PA &#40;&#8804;<span class="elsevierStyleHsp" style=""></span>102<span class="elsevierStyleHsp" style=""></span>cm en hombres y &#8804;<span class="elsevierStyleHsp" style=""></span>88<span class="elsevierStyleHsp" style=""></span>cm en mujeres&#41; o su PGC &#40;&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; en hombres y &#8804;<span class="elsevierStyleHsp" style=""></span>35&#37; en mujeres&#41; a los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">An&#225;lisis estad&#237;stico</span><p id="par0100" class="elsevierStylePara elsevierViewall">Se realiz&#243; con el paquete estad&#237;stico STATA&#46; Se calcularon las medias &#177;<span class="elsevierStyleHsp" style=""></span>desviaciones est&#225;ndar para las variables cuantitativas y los porcentajes de participantes en cada categor&#237;a para las variables cualitativas&#46; Los grupos se compararon utilizando el test de chi cuadrado para las proporciones y el test de Student o el an&#225;lisis de la varianza para las medias &#177;<span class="elsevierStyleHsp" style=""></span>desviaciones est&#225;ndar&#46; La asociaci&#243;n de las proporciones de los que dejaron de tener cada una de las tres obesidades con el resto de variables del estudio se comput&#243; como la odds ratio &#40;OR&#41; de cada una de las variables en las proporciones de los que hab&#237;an dejado de tener cada obesidad a los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os divididas por la OR de las proporciones de los participantes que segu&#237;an teniendo esas obesidades&#46; Se utilizaron modelos mixtos de regresi&#243;n log&#237;stica multivariantes para el ajuste de potenciales variables de confusi&#243;n y para obtener las odd ratios ajustadas &#40;ORA&#41;&#46;<elsevierMultimedia ident="fig0005"></elsevierMultimedia></p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Resultados</span><p id="par0105" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> presenta las caracter&#237;sticas principales de las muestras&#46; Se observa que la proporci&#243;n de OG en los participantes con PA elevado &#40;52&#44;9&#37;&#41; es mayor &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; que en los que tienen PGC elevado &#40;44&#44;5&#37;&#41;&#59; la proporci&#243;n de OA en los participantes con IMC elevado &#40;90&#44;4&#37;&#41; es mayor &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; que en los que tienen PGC elevado &#40;69&#44;7&#37;&#41;&#44; y la proporci&#243;n de EGC en los participantes con IMC elevado &#40;87&#44;0&#37;&#41; es mayor &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; que en los que tienen PA elevado &#40;79&#44;8&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> muestra la proporci&#243;n de los que dejan de tener OG&#44; OA o EGC a los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; siendo significativamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; m&#225;s alta la proporci&#243;n de EGC que las de OG u OA&#46; Tambi&#233;n muestra que la proporci&#243;n de hombres que dejan de tener OA es significativamente mayor que la de las mujeres &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">De 2&#46;054 participantes con uno o m&#225;s tipos de obesidad en la captaci&#243;n y datos v&#225;lidos a los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; 240 &#40;11&#44;6&#37;&#41; participantes &#40;108 &#91;15&#44;2&#37;&#93; hombres y 132 &#91;9&#44;8&#37;&#93; mujeres&#41; hab&#237;an normalizado todos sus &#237;ndices diagn&#243;sticos de obesidad en ese tiempo&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#58; de 89 participantes con IMC normal&#44; 30 &#40;33&#44;7&#37;&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 24&#44;0-44&#44;5&#41; lo hab&#237;an normalizado antes de los 6<span class="elsevierStyleHsp" style=""></span>meses&#59; de 177 participantes con PA normal&#44; 59 &#40;33&#44;3&#37;&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 26&#44;6-40&#44;7&#41; lo hab&#237;an normalizado antes de los 6<span class="elsevierStyleHsp" style=""></span>meses&#44; y de 335 participantes con PGC normal&#44; 103 &#40;30&#44;7&#37;&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 25&#44;8-35&#44;9&#41; lo hab&#237;an normalizado antes de los 6<span class="elsevierStyleHsp" style=""></span>meses&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se observa que&#58; son mayores los aumentos en los niveles de AF en MET-h&#47;semana &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y minutos&#47;semana &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41; en los que dejan de tener OG y el aumento del VO<span class="elsevierStyleInf">2</span>max &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41; en los que dejan de tener OA o EGC que en los que siguen con esas obesidades&#59; los que dejan de tener OG son los que m&#225;s reducen su peso y su IMC &#40;6&#44;8<span class="elsevierStyleHsp" style=""></span>kg y 2&#44;6<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> frente a 2&#44;5 y 0&#44;9 de la OA y 2&#44;8 y 1 del EGC&#41;&#44; as&#237; como los que m&#225;s aumentan sus niveles de AF &#40;0&#44;9 MET-h&#47;semana y 60<span class="elsevierStyleHsp" style=""></span>minutos&#47;semana frente a 0&#44;3 y 0&#44;2 MET-h&#47;semana y 20 y 8<span class="elsevierStyleHsp" style=""></span>minutos&#47;semana de la OA y el EGC&#44; respectivamente&#41;&#59; los que dejan de tener OA son los que m&#225;s PA pierden &#40;8&#44;2<span class="elsevierStyleHsp" style=""></span>cm frente a 6&#44;5 y 3&#44;4&#44; respectivamente&#44; de la OG y el EGC&#41;&#59; y los que dejan de tener EGC son los que m&#225;s PGC pierden &#40;4&#44;1&#37; frente al 2&#44;8&#37; y al 2&#44;4&#37;&#44; respectivamente&#44; de la OG y la OA&#41; y los que m&#225;s aumentan su VO<span class="elsevierStyleInf">2</span>max &#40;1&#44;7 frente a 1&#44;2 y 1&#44;0<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;min&#44; respectivamente&#44; de la OG y la OA&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Como muestra la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#44; a los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#58; los que dejan de tener OA tienen una proporci&#243;n mayor &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; de los que siguen fumando y menor de los que siguen sin fumar&#59; los que dejan de tener OG tienen una proporci&#243;n mayor &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;013&#41; de los que dejan de cumplir las recomendaciones de AF y menor de los que siguen sin cumplirlas&#59; y los que dejan de tener OG&#44; OA o EGC tienen una proporci&#243;n menor &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; de los que mantienen una mala FFCR y mayor de los que la mantienen buena&#46; As&#237; mismo&#44; los que dejan de tener OG tienen porcentajes de OA y de EGC menores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#59; los que dejan de tener OA tienen porcentajes de OG y de EGC menores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; y los que dejan de tener EGC tienen porcentajes de OA menores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Al analizar la relaci&#243;n de las obesidades entre s&#237;&#44; entre los que normalizan su IMC a los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os el 22&#37; han normalizado tambi&#233;n su PA m&#225;s su PGC&#44; el 20&#37; solo su PA y el 18&#37; solo su PGC&#44; pero queda un 39&#37; con un PA m&#225;s un PGC elevados que no elevan el IMC&#46; Entre los que normalizan su PA a los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os el 47&#37; han normalizado tambi&#233;n su IMC m&#225;s PGC&#44; el 33&#37; solo su IMC y el 6&#37; solo su PGC&#44; pero queda un 15&#37; con un PA normal y un PGC elevado que tambi&#233;n elevan el IMC&#46; Entre los que normalizan su PGC a los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os el 56&#37; han normalizado tambi&#233;n su IMC m&#225;s su PA&#44; el 27&#37; solo su IMC y el 4&#37; solo su PA&#44; pero queda un 13&#37; con un PGC normal y un PA elevado que tambi&#233;n elevan el IMC&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En las <a class="elsevierStyleCrossRefs" href="#tbl0025">tablas 5 y 6</a> se puede ver que&#58; dejar de tener OG solo se asocia con ser mujer&#44; tener hipertensi&#243;n y el cambio en la FFCR&#59; dejar de tener OA solo se asocia con la edad&#44; el cumplimiento de las recomendaciones de AF en la captaci&#243;n y el cambio de ese cumplimiento y en la FFCR a los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; y dejar de tener EGC solo se asocia con la edad y el cambio en la FFCR a los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discusi&#243;n</span><p id="par0145" class="elsevierStylePara elsevierViewall">Como muestran los resultados de este estudio&#44; es posible dejar de tener cualquiera de las tres obesidades o las tres juntas&#59; es decir&#44; normalizar el IMC&#44; el PA y&#47;o el PGC a los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; En concreto&#44; el 11&#44;6&#37; de los participantes con uno o m&#225;s tipos de obesidad en la captaci&#243;n pasan a ser normales en ese tiempo&#44; y alrededor de un tercio lo hacen antes de los 6<span class="elsevierStyleHsp" style=""></span>meses&#46; Y analizando las tres obesidades por separado&#44; el 20&#37; han dejado de tener EGC&#44; el 12&#37; OA y el 11&#37; OG en ese tiempo&#46; Luego&#44; es posible dejar de tener la enfermedad de la obesidad y mantenerse sin ella&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Los resultados tambi&#233;n indican que lo primero que disminuye es un conjunto de grasa general y abdominal subcut&#225;nea&#44; o PGC&#44; y despu&#233;s se une una disminuci&#243;n de grasa abdominal &#40;visceral y&#47;o subcut&#225;nea&#41;&#44; o PA&#44; que alcanzan en un momento dado un impacto en el peso corporal suficiente para reducir el IMC por debajo de 30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">De lo anterior se deriva que&#58; puede ser m&#225;s dif&#237;cil normalizar el IMC&#44; dado que para reducir el IMC hay que conseguir reducir a la vez el PA y el PGC en cifras superiores a los de otras obesidades&#59; el EGC revierte m&#225;s a los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; posiblemente porque la acumulaci&#243;n excesiva de grasa abdominal constituye el 70&#37; de la de grasa corporal total &#40;de EGC&#41;&#44; significando que la grasa que primero se pierde es la perif&#233;rica&#44; que suele ser m&#225;s subcut&#225;nea que visceral&#44; y despu&#233;s se pierde la grasa visceral del abdomen<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">21</span></a>&#59; cuando la p&#233;rdida de grasa de los dos tipos alcanza una cantidad que supone un determinado peso corporal&#44; se reduce el IMC y se deja de tener OG&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Cuando consideramos libres de obesidad a aquellos con IMC<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; todav&#237;a hay una proporci&#243;n considerable de OA y&#47;o de EGC entre ellos&#44; mientras que cuando consideramos libres de obesidad a aquellos con PA normal&#44; la proporci&#243;n de los que siguen con OG o EGC entre ellos es mucho menor&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Cada a&#241;o de aumento en la edad supone un 3&#37; menos probabilidad de dejar de tener OA o EGC a los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; lo que significa que a mayor edad cuesta m&#225;s trabajo perder grasa&#44; porque con el envejecimiento va disminuyendo la masa muscular y aumentando la masa grasa<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">A los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; pasar de una mala a buena FFCR desde la captaci&#243;n y mantenerla buena en ese tiempo se asocia&#44; respectivamente&#44; con una mayor probabilidad &#40;del 166&#37; y del 289&#37;&#41; de dejar de tener OG&#44; y una mayor probabilidad &#40;del 99&#37; y del 199&#37;&#41; de dejar de tener EGC&#59; y dejar de cumplir las recomendaciones sobre AF desde la captaci&#243;n y mantener una buena FFCR en ese tiempo se asocia&#44; respectivamente&#44; con una mayor probabilidad &#40;del 149&#37; y del 182&#37;&#41; de dejar de tener OA a los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">No hemos encontrado ning&#250;n estudio en que el objetivo sea la desaparici&#243;n de la obesidad&#46; Sin embargo&#44; en un estudio americano sobre la incidencia de obesidad<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a> se informa que entre 1990 y 2000&#44; despu&#233;s de 8<span class="elsevierStyleHsp" style=""></span>a&#241;os de seguimiento&#44; el 10&#44;8&#37; de sujetos con IMC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> &#40;11&#37; de hombres y 10&#44;7&#37; de mujeres&#41; reduc&#237;an su IMC por debajo de esa cifra&#46; Esos porcentajes son similares a los de este estudio&#44; que ser&#237;a el primer estudio en demostrar que la obesidad&#44; como enfermedad&#44; es reversible&#46; S&#237; hay muchos estudios de intervenci&#243;n en la obesidad cuyo objetivo es disminuir el peso corporal<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a> o la grasa visceral<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">24&#44;25</span></a> o general<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">24&#44;26</span></a> en un determinado porcentaje o hasta un determinado l&#237;mite&#46;</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Limitaciones y fortalezas</span><p id="par0180" class="elsevierStylePara elsevierViewall">Posibles limitaciones de este estudio son&#58; la fecha de los datos recogidos &#40;2003-2006&#41;&#44; que har&#237;a que las cifras hayan cambiado&#44; pero dan idea de las posibilidades de revertir la obesidad&#59; y la posibilidad de que la p&#233;rdida de peso se debiera a una enfermedad cr&#243;nica adelgazante&#44; pero se puede argumentar que los participantes con esas enfermedades no acudieron a las mediciones o no se les realizaron&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Se podr&#237;a se&#241;alar como limitaci&#243;n el hecho de que se trata de una muestra en la que una parte de ella ha sido intervenida con el PAF para aumentar sus niveles de AF&#46; Pero ese hecho tiene el mismo impacto en los porcentajes que si el participante ha seguido un plan de reducci&#243;n de dieta y&#47;o de aumento de AF adoptado por s&#237; mismo o prescrito por un profesional sanitario&#44; porque para que una persona deje de ser obesa necesita obligatoriamente una intervenci&#243;n con dieta y&#47;o ejercicio&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Como fortalezas se puede se&#241;alar el entrenamiento del personal investigador y el control de calidad llevado a cabo en el estudio PEPAF&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conclusiones</span><p id="par0195" class="elsevierStylePara elsevierViewall">La obesidad como enfermedad cr&#243;nica se diferencia de las dem&#225;s en que es posible &#171;curarse&#187; de ella normalizando la cantidad de grasa corporal y manteni&#233;ndose as&#237;&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">A los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; lo que m&#225;s se normaliza es el PGC y con ello el EGC&#44; despu&#233;s el PA y con ello la OA&#44; y por &#250;ltimo el IMC y con ello la OG&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Entre los que normalizan su IMC&#44; la mitad siguen teniendo OA o EGC&#44; mientras que entre los que normalizan su PA&#44; solo una quinta parte siguen teniendo OG o EGC&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Consideraciones &#233;ticas</span><p id="par0210" class="elsevierStylePara elsevierViewall">El protocolo del Estudio PEPAF fue aprobado por los comit&#233;s &#233;ticos de investigaci&#243;n de todos los centros de salud participantes&#46; Se solicit&#243; el consentimiento informado a todos los participantes para su inclusi&#243;n en el Estudio PEPAF&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Fuentes de financiaci&#243;n</span><p id="par0215" class="elsevierStylePara elsevierViewall">La presente investigaci&#243;n no ha recibido ayudas espec&#237;ficas provenientes de agencias del sector p&#250;blico&#44; sector comercial o entidades sin &#225;nimo de lucro&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">El Estudio PEPAF se financi&#243; con una beca del Instituto de Salud Carlos<span class="elsevierStyleHsp" style=""></span>III del Ministerio de Sanidad&#44; y se cofinanci&#243; con una ayuda del ERDF de la Uni&#243;n Europea &#40;FIS PI02&#47;0015&#59; RETICS G03&#47;170 y RD06&#47;0018&#47;0018&#59; CAIBERCAI08&#47;01&#47;0065&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Datos y c&#243;digo anal&#237;tico</span><p id="par0225" class="elsevierStylePara elsevierViewall">Est&#225;n disponibles por petici&#243;n razonada&#46; Los datos son solo los correspondientes a este art&#237;culo y proceden del Estudio PEPAF&#46; Las peticiones deber&#225;n dirigirse al autor de correspondencia&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Autor&#237;a</span><p id="par0230" class="elsevierStylePara elsevierViewall">Ricardo Ortega&#58; concepci&#243;n y dise&#241;o del estudio&#44; an&#225;lisis e interpretaci&#243;n de los datos&#44; borrador del art&#237;culo y aprobaci&#243;n definitiva de la versi&#243;n que se presenta&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Gonzalo Grandes&#58; adquisici&#243;n de datos&#44; revisi&#243;n cr&#237;tica del contenido intelectual y aprobaci&#243;n definitiva de la versi&#243;n que se presenta&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Sagrario G&#243;mez-Cantarino&#58; concepci&#243;n y dise&#241;o del estudio&#44; revisi&#243;n cr&#237;tica del contenido intelectual y aprobaci&#243;n definitiva de la versi&#243;n que se presenta&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflicto de intereses</span><p id="par0245" class="elsevierStylePara elsevierViewall">Los autores no tienen ning&#250;n conflicto de intereses que declarar&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Averiguar en qu&#233; medida es posible dejar de tener obesidad &#40;normalizar el &#237;ndice de masa corporal &#91;IMC&#93;&#44; el per&#237;metro abdominal &#91;PA&#93; y&#47;o el porcentaje de grasa corporal &#91;PGC&#93;&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio de observaci&#243;n longitudinal y retrospectiva&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Emplazamiento</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Once centros de salud espa&#241;oles&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Participantes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Hombres y mujeres con IMC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;246&#41; u obesidad general &#40;OG&#41;&#44; con PA<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>102<span class="elsevierStyleHsp" style=""></span>cm y &#62;<span class="elsevierStyleHsp" style=""></span>88<span class="elsevierStyleHsp" style=""></span>cm&#44; respectivamente &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;122&#41; u obesidad abdominal &#40;OA&#41; y con PGC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; y &#62;<span class="elsevierStyleHsp" style=""></span>35&#37;&#44; respectivamente &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;436&#41; o exceso de grasa corporal &#40;EGC&#41;&#44; de la cohorte del Estudio PEPAF de 4&#46;927 participantes de 20 a 80<span class="elsevierStyleHsp" style=""></span>a&#241;os de edad&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Mediciones principales</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Datos procedentes del Estudio PEPAF de la captaci&#243;n y de 6&#44; 12 y 24<span class="elsevierStyleHsp" style=""></span>meses&#58; sexo&#44; edad&#44; diagn&#243;sticos de diabetes&#44; hipertensi&#243;n arterial y dislipemia&#44; h&#225;bito tab&#225;quico&#44; niveles y cumplimiento de las recomendaciones de actividad f&#237;sica&#44; consumo m&#225;ximo de ox&#237;geno&#44; peso&#44; talla&#44; PA y tres pliegues grasos cut&#225;neos &#40;tor&#225;cico&#44; umbilical y muslo anterior para hombres y tr&#237;ceps&#44; suprail&#237;aco y muslo anterior para mujeres&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Resultados</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">De 2&#46;054 participantes con cualquier tipo de obesidad en la captaci&#243;n y datos v&#225;lidos a los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; 240 &#40;11&#44;6&#37;&#41; hab&#237;an normalizado todos sus &#237;ndices diagn&#243;sticos de obesidad en ese tiempo&#46; El 19&#44;5&#37; &#40;intervalo de confianza al 95&#37; &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#41;&#58; 17&#44;6-21&#44;4&#41; hab&#237;an dejado de tener EGC&#44; el 12&#44;0&#37; &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 10&#44;4-13&#44;7&#41; hab&#237;an dejado de tener OA y el 10&#44;5&#37; &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 8&#44;5-12&#44;7&#41; hab&#237;an dejado de tener OG&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La obesidad se diferencia de las dem&#225;s enfermedades cr&#243;nicas en que es posible &#171;curarse&#187; de ella normalizando la cantidad de grasa corporal&#46;</p></span>"
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        "resumen" => "<span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Aim</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To ascertain to what extent it is possible to stop being obese &#40;to normalize body mass index &#91;BMI&#93;&#44; waist circumference &#91;WC&#93; and&#47;or body fat percentage &#91;BFP&#93;&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Design</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Longitudinal observational and retrospective study&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Site</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Eleven Spanish health centers&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Participants</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Men and women with BMI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1246&#41; or general obesity &#40;GO&#41;&#44; with WC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>102<span class="elsevierStyleHsp" style=""></span>cm and &#62;<span class="elsevierStyleHsp" style=""></span>88<span class="elsevierStyleHsp" style=""></span>cm&#44; respectively &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2122&#41; or abdominal obesity &#40;AO&#41; and with BFP<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; and &#62;<span class="elsevierStyleHsp" style=""></span>35&#37;&#44; respectively &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2436&#41; or excess body fat &#40;EBF&#41;&#44; from the PEPAF Study cohort of 4927 participants aged 20-80<span class="elsevierStyleHsp" style=""></span>years&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Main measurements</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Data from the PEPAF study at baseline and at 6&#44; 12 and 24<span class="elsevierStyleHsp" style=""></span>months&#58; gender&#44; age&#44; diagnoses of diabetes&#44; hypertension and dyslipidemia&#44; smoking&#44; levels of and compliance with physical activity recommendations&#44; maximum oxygen consumption&#44; weigh&#44; height&#44; WC and three skin-folds &#40;thoracic&#44; umbilical and anterior thigh for men and triceps&#44; suprailiac and anterior thigh for women&#41;&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Of 2054 participants with any type of obesity at baseline and valid data at 2<span class="elsevierStyleHsp" style=""></span>years&#44; 240 &#40;11&#46;6&#37;&#41; had normalized all of their obesity diagnostic indexes&#46; 19&#46;5&#37; &#40;95&#37; confidence interval &#40;95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 17&#46;6-21&#46;4&#41; ceased to have EBF&#44; 12&#46;0&#37; &#40;95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 10&#46;4-13&#46;7&#41; ceased to have AO and 10&#46;5&#37; &#40;95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 8&#46;5-12&#46;7&#41; ceased to have GO&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusions</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Obesity differs from other chronic diseases in that it can be &#171;cured&#187; by normalizing the amount of body fat&#46;</p></span>"
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            "apendice" => "<p id="par0255" class="elsevierStylePara elsevierViewall">Equipo Directivo&#58; Unidad de Investigaci&#243;n en Atenci&#243;n Primaria de Bizkaia&#44; Servicio Vasco de Salud-Osakidetza&#46; Investigador principal&#58; Gonzalo Grandes&#59; co-investigadores&#58; Jes&#250;s Torcal&#44; Ricardo Ortega&#44; Alvaro S&#225;nchez&#44; Kepa Lizarraga&#44; Javier Serra&#44; Imanol Montoya&#46;</p> <p id="par0260" class="elsevierStylePara elsevierViewall">Servicio Vasco de Salud-Osakidetza&#58; Centro de Salud de Basauri-Ar&#237;z&#58; Angel Fern&#225;ndez&#44; Victor Manuel L&#243;pez&#44; Lourdes Mariju&#225;n&#44; Bego&#241;a Etxeguren&#44; Victor Landa&#44; Jes&#250;s Mart&#237;nez&#44; M&#46; Mercedes D&#237;ez&#44; Juan Ram&#243;n Lejarza&#44; Judith Gonz&#225;lez&#46; Centro de Salud de Galdakao&#58; Vidal Salcedo&#44; Idoia Ib&#225;&#241;ez&#44; Agurtzane Ortego&#44; Pedro Iraguen&#44; Pilar Echevarria&#44; Virginia Villaverde&#46; Centro de Salud de Algorta&#58; Amaia Ecenarro&#44; M&#46; Teresa Uribe&#44; Carmen Moral&#44; Eguski&#241;e Iturregui&#44; Ana Bel&#233;n Fern&#225;ndez&#46;</p> <p id="par0265" class="elsevierStylePara elsevierViewall">Servicio Andaluz de Salud&#58; Centro de Salud de Camas&#44; Sevilla&#58; Jos&#233; Mar&#237;a P&#225;ez&#44; M&#46; &#193;ngeles Tarilonte&#44; Concepci&#243;n Molina&#44; Vicente Rodr&#237;guez&#44; Isabel Villafuente&#44; Mercedes &#193;lvarez&#46;</p> <p id="par0270" class="elsevierStylePara elsevierViewall">Servicio de Salud de Islas Baleares&#58; Centro de Salud de Dalt Sant Joan&#44; Mah&#243;n&#58; Andreu Estela&#44; Jos&#233; Mar&#237;a Coll&#44; &#192;ngels Llach&#44; Josep M&#46; Masuet&#44; Ana Moll&#44; Monica Pons&#46;</p> <p id="par0275" class="elsevierStylePara elsevierViewall">Servicio Catal&#225;n de Salud&#58; Centro de Salud de Serraparera&#44; Barcelona&#58; Bonaventura Bolibar&#44; Agust&#237; Guiu&#44; Amadeu D&#237;az&#44; Xavier Mart&#237;nez&#44; M&#46; Dolores Hern&#225;ndez&#44; Jos&#233; Ignacio Olivares&#44; Francisco Hernansanz&#44; Rita Ayala&#44; Ana Cascos&#46;</p> <p id="par0280" class="elsevierStylePara elsevierViewall">Servicio de Salud de Castilla-La Mancha&#58; Centro de Salud de San Fernando Cuenca<span class="elsevierStyleHsp" style=""></span>III&#44; Cuenca&#58; Vicente Mart&#237;nez&#44; M&#46; del Carmen Garc&#237;a&#44; M&#46; &#193;ngeles Gabriel&#44; M&#46; Luscinda Vel&#225;zquez&#44; Natividad Ortega&#44; M&#46; Jes&#250;s Segura&#44; Rodrigo Cerrillo&#44; Patricia L&#243;pez&#46;</p> <p id="par0285" class="elsevierStylePara elsevierViewall">Servicio de Salud de Castilla y Le&#243;n&#58; Centro de Salud de Casa Barco&#44; Valladolid&#58; Carmen Fern&#225;ndez&#44; Amparo G&#243;mez&#44; Miguel &#193;ngel D&#237;ez&#44; Ruperto Sanz&#44; Luis Miguel Quintero&#44; Jos&#233; Ignacio Recio&#46; Centro de Salud La Alamedilla&#44; Salamanca&#58; Luis Garc&#237;a&#44; Jos&#233; Antonio Iglesias&#44; Manuel G&#243;mez&#44; Emilio Ramos&#44; Pilar Moreno&#44; Yolanda Casta&#241;o&#44; Nadia Carrillo&#46;</p> <p id="par0290" class="elsevierStylePara elsevierViewall">Servicio Gallego de Salud&#58; Centro de Salud de Sardoma&#44; Vigo&#58; Pilar Gayoso&#44; Luciano Casariego&#44; Manuel Dom&#237;nguez&#44; Jos&#233; Ram&#243;n Moliner&#44; Fernando Lago&#44; M&#46; Concepci&#243;n Cruces&#44; Marisa Enr&#237;quez&#46;</p> <p id="par0295" class="elsevierStylePara elsevierViewall">Servicio Madrile&#241;o de Salud&#58; Centro de Guayaba&#44; Madrid&#58; Tom&#225;s G&#243;mez&#44; Javier Mart&#237;nez&#44; Jos&#233; Antonio Granados&#44; M&#46; &#193;ngeles Fern&#225;ndez&#44; M&#46; Isabel Guti&#233;rrez&#44; Carlos San Andr&#233;s&#44; Concepci&#243;n Vargas-Machuca&#44; Cristina D&#237;az&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p>"
            "etiqueta" => "Anexo 1"
            "titulo" => "Miembros del Grupo PEPAF"
            "identificador" => "sec0080"
          ]
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">AF&#58; actividad f&#237;sica&#59; DM2&#58; diabetes mellitus tipo 2&#59; EGC&#58; exceso de grasa corporal&#44; FFCR&#58; forma f&#237;sica cardiorrespiratoria&#59; HTA&#58; hipertensi&#243;n arterial&#59; IMC&#58; &#237;ndice de masa corporal &#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#59; MET-h&#47;s&#58; unidades metab&#243;licas por hora a la semana&#59; Min&#47;sem&#58; minutos a la semana&#59; OA&#58; obesidad abdominal&#59; OG&#58; obesidad general&#59; PA&#58; per&#237;metro abdominal &#62;<span class="elsevierStyleHsp" style=""></span>102<span class="elsevierStyleHsp" style=""></span>cm en hombres y 88<span class="elsevierStyleHsp" style=""></span>cm en mujeres&#59; PGC&#58; porcentaje de grasa corporal &#62;<span class="elsevierStyleHsp" style=""></span>25&#37; en hombres y &#62;<span class="elsevierStyleHsp" style=""></span>35&#37; en mujeres&#59; RAF&#58; recomendaciones de actividad f&#237;sica&#59; VO<span class="elsevierStyleInf">2</span>max&#58; consumo m&#225;ximo de ox&#237;geno&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Variables edad&#44; peso&#44; IMC&#44; PA&#44; PGC&#44; VO2max y AF expresadas en media &#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar&#46; Resto de variables expresadas como &#37; &#40;intervalo de confianza al 95&#37;&#41;&#46;</p>"
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#9792;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>828&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Totaln<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;122&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#9794;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>474&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#9792;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;648&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#9792;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;582&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad&#44; a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">55&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">54&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">86&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">78&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">92&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">74&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">78&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">85&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">74&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No-S&#237; vs&#46; No-No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;07 &#40;0&#44;67-1&#44;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>S&#237;-No vs&#46; No-No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;49 &#40;1&#44;22-5&#44;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>S&#237;-S&#237; vs&#46; No-No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;41 &#40;0&#44;69-2&#44;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">FFCR</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mala-Buena vs&#46; Mala-Mala&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;64 &#40;0&#44;95-2&#44;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;42 &#40;0&#44;72-2&#44;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;82 &#40;1&#44;64-4&#44;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Exceso de grasa corporal</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">FFCR</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mala-Buena vs&#46; Mala-Mala&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;99 &#40;1&#44;34-2&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Buena-Mala vs&#46; Mala-Mala&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;83 &#40;0&#44;45-1&#44;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Buena-Buena vs&#46; Mala-Mala&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;99 &#40;2&#44;03-4&#44;41&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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          "es" => "<p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Asociaciones de cambio de h&#225;bitos con la probabilidad de dejar de tener alguna de las tres obesidades a los 2 a&#241;os&#58; odds ratios con ajuste multivariante</p>"
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          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Lo conocido sobre el tema</span><p id="par0300" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0305" class="elsevierStylePara elsevierViewall">La obesidad es considerada una enfermedad cr&#243;nica como la hipertensi&#243;n&#44; la diabetes o la dislipemia&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0310" class="elsevierStylePara elsevierViewall">Se produce por un balance energ&#233;tico positivo&#58; la ingesta de calor&#237;as supera al gasto&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0315" class="elsevierStylePara elsevierViewall">Todas las intervenciones van dirigidas a reducir el peso o la grasa corporal pero no a &#171;curarla&#187;&#46;</p></li></ul></p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Qu&#233; aporta este estudio</span><p id="par0320" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0325" class="elsevierStylePara elsevierViewall">La obesidad se puede &#171;curar&#187;&#44; a diferencia de las otras enfermedades cr&#243;nicas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0330" class="elsevierStylePara elsevierViewall">Es posible dejar de tener obesidad general &#40;OG&#41;&#44; obesidad abdominal &#40;OA&#41; y&#47;o exceso de grasa corporal &#40;EGC&#41; a los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0335" class="elsevierStylePara elsevierViewall">Entre los que normalizan su &#237;ndice de masa corporal&#44; la mitad siguen con OA o EGC&#44; mientras que entre los que normalizan su per&#237;metro abdominal&#44; solo la quinta parte siguen con OA o EGC&#46;</p></li></ul></p></span></span>"
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                0 => array:2 [
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                      "titulo" => "Obesity as a disease&#58; The obesity society 2018 position statement"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;M&#46; Jastreboff"
                            1 => "C&#46;M&#46; Kotz"
                            2 => "S&#46; Kahan"
                            3 => "A&#46;S&#46; Kelly"
                            4 => "S&#46;B&#46; Heymsfield"
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                      "doi" => "10.1002/oby.22378"
                      "Revista" => array:6 [
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                        "paginaInicial" => "7"
                        "paginaFinal" => "9"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30569641"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention&#44; diagnosis&#44; and treatment of obesity&#46; 2016 position statement of the Spanish Society for the Study of Obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Lecube"
                            1 => "S&#46; Monereo"
                            2 => "M&#46;A&#46; Rubio"
                            3 => "P&#46; Mart&#237;nez-de-Icaya"
                            4 => "A&#46; Mart&#237;"
                            5 => "J&#46; Salvador"
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                    0 => array:2 [
                      "doi" => "10.1016/j.endonu.2016.07.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Endocrinol Nutr&#46;"
                        "fecha" => "2016"
                        "volumen" => "64"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "15"
                        "paginaFinal" => "22"
                      ]
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              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Roadmaps for Clinical Practice&#58; Case Studies in Disease Prevention and Health Promotion &#8212; Assessment and Management of Adult Obesity&#58; A Primer for Physicians"
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                        0 => array:2 [
                          "etal" => false
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                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2003"
                        "editorial" => "American Medical Association"
                        "editorialLocalizacion" => "Chicago&#44; Ill"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "International Day for the Evaluation of Abdominal Obesity &#40;IDEA&#41;&#46; A study of waist circumference&#44; cardiovascular disease&#44; and diabetes mellitus in 168&#44;000 primary care patients in 63 countries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Balkau"
                            1 => "J&#46;E&#46; Deanfield"
                            2 => "J&#46;P&#46; Despr&#233;s"
                            3 => "J&#46;P&#46; Bassan"
                            4 => "K&#46;A&#46;A&#46; Fox"
                            5 => "S&#46;C&#46; Smith Jr&#46;"
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                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.106.676379"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation&#46;"
                        "fecha" => "2007"
                        "volumen" => "116"
                        "paginaInicial" => "1942"
                        "paginaFinal" => "1951"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17965405"
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                  "contribucion" => array:1 [
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                      "titulo" => "Population-based prevention of obesity&#58; The need for comprehensive promotion of healthful eating&#44; physical activity&#44; and energy balance&#58; A scientific statement from American Heart Association Council on Epidemiology and Prevention&#44; Interdisciplinary Committee for Prevention &#40;formerly the expert panel on population and prevention science&#41;"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;K&#46; Kumanyika"
                            1 => "E&#46; Obarzanek"
                            2 => "N&#46; Stettler"
                            3 => "R&#46; Bell"
                            4 => "A&#46;E&#46; Field"
                            5 => "S&#46;P&#46; Fortmann"
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Información del artículo
ISSN: 02126567
Idioma original: Español
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